#health insurance struggles

[health-insurance-struggles]

Medical Binder

You need a three ring binder. And sheet protectors. And tabs. “Why?”

‘Cause you need a medical binder.

What is a medical binder? A place that you store your medical information paperwork. All of it.

Why should I have this? Documentation. Insurance and medical care are all about documentation. If it’s not in writing, it didn’t happen and doesn’t exist. Why can’t you do it electronically? Because the internet can be compromised. No one can hack a piece of paper from a thousand miles away. Having a copy of your medical records means you have easy access to talk to a new doctor and get them up to speed.

For my fellow chronic illness people, this is what keeps you from going batsh*t insane if you see a new doctor or need to go to the hospital.

What should go in it?

Medical Records: This is a copy of whatever records you have from whatever appointments/visits you go to. Have a check-up? Get a printed copy. Have lab work run? Get a printed copy of records. ER visit? Printed copy. Surgery? Printed copy. Vaccine? Printed copy. I recommend having documentation going back at least five years. Include lists of any medications you’ve taken, along with start/stop dates. This is ideally a catch-all of everything you would want to tell a brand new doctor so they can immediately pick up where your last doctor left off. If you have chronic illnesses, this is where you want to include a history of it. Diagnosis, medications and treatments that have worked and not worked, and all symptoms/progressions you’ve noticed.

Medical Bills: Did you pay a bill? Print a copy of the receipt? Did you get a bill? Save it and then add the receipt after you pay it. Collections notice? Financial Hardship paperwork? Payment plan agreements? Print and add here.

Insurance Paperwork A copy of your ID card, a copy of your summary plan document, and any copies of your claims. Print it and save it.

Misc. Anything else related to your healthcare/bills that you could need. If you think in five years there is the remote possibility you could need this specific piece of paper, print it and save it.

These documents are important to have. If you're in an accident and you have everything on hand (or can have someone bring you everything), you're already ten steps ahead. Otherwise, your new doctor has to have you sign a HIPAA form for every single doctor you've ever seen so they can send your records to be reviewed blah blah blah. The main point is that process is time consuming and frustrating. Save everyone (and yourself) the headache.

[health-insurance-struggles]

As an aside, if a doctor refuses to run tests or take it seriously, always ask them to document in your chart that they refused to investigate. Then ask for a copy of the chart.

If something ever happens and that doctor didn't do anything, congratulations! You have a record and you can easily file a complaint with whoever you want. If it's bad enough, you can file a lawsuit.

Documentation is key. If the doctor refuses to listen, make sure they write down that they refused and give you a copy.

Doctors tend to be a lot more willing to listen when you want a copy of their notes.

The biggest male privilege I have so far encountered is going to the doctor.

I lived as a woman for 35 years. I have a lifetime of chronic health issues including chronic pain, chronic fatigue, respiratory issues, and neurodivergence (autistic + ADHD). There's so much wrong with my body and brain that I have never dared to make a single list of it to show a doctor because I was so sure I would be sent directly to a psychologist specializing in hypochondria (sorry, "anxiety") without getting a single test done.

And I was right. Anytime I ever tried to bring up even one of my health issues, every doctor's initial reaction was, at best, to look at me with doubt. A raised eyebrow. A seemingly casual, offhand question about whether I'd ever been diagnosed with an anxiety disorder. Even female doctors!

We're not talking about super rare symptoms here either. Joint pain. Chronic joint pain since I was about 19 years old. Back pain. Trouble breathing. Allergy-like reactions to things that aren't typically allergens. Headaches. Brain fog. Severe insomnia. Sensitivity to cold and heat.

There's a lot more going on than that, but those were the things I thought I might be able to at least get some acknowledgement of. Some tests, at least. But 90% of the time I was told to go home, rest, take a few days off work, take some benzos (which they'd throw at me without hesitation), just chill out a bit, you'll be fine. Anxiety can cause all kinds of odd symptoms.

Anyone female-presenting reading this is surely nodding along. Yup, that's just how doctors are.

Except...

I started transitioning about 2.5 years ago. At this point I have a beard, male pattern baldness, a deep voice, and a flat chest. All of my doctors know that I'm trans because I still haven't managed to get all the paperwork legally changed, but when they look at me, even if they knew me as female at first, they see a man.

I knew men didn't face the same hurdles when it came to health care, but I had no idea it was this different.

The last time I saw my GP (a man, fairly young, 30s or so), I mentioned chronic pain, and he was concerned to see that it wasn't represented in my file. Previous doctors hadn't even bothered to write it down. He pushed his next appointment back to spend nearly an hour with me going through my entire body while I described every type of chronic pain I had, how long I'd had it, what causes I was aware of. He asked me if I had any theories as to why I had so much pain and looked at me with concerned expectation, hoping I might have a starting point for him. He immediately drew up referrals for pain specialists (a profession I didn't even know existed till that moment) and physical therapy. He said depending on how it goes, he may need to help me get on some degree of disability assistance from the government, since I obviously shouldn't be trying to work full-time under these circumstances.

Never a glimmer of doubt in his eye. Never did he so much as mention the word "anxiety".

There's also my psychiatrist. He diagnosed me with ADHD last year (meeting me as a man from the start, though he knew I was trans). He never doubted my symptoms or medical history. He also took my pain and sleep issues seriously from the start and has been trying to help me find medications to help both those things while I go through the long process of seeing other specialists. I've had bad reactions to almost everything I've tried, because that's what always happens. Sometimes it seems like I'm allergic to the whole world.

And then, just a few days ago, the most shocking thing happened. I'd been wondering for a while if I might have a mast cell condition like MCAS, having read a lot of informative posts by @thebibliosphere which sounded a little too relatable. Another friend suggested it might explain some of my problems, so I decided to mention it to the psychiatrist, fully prepared to laugh it off. Yeah, a friend thinks I might have it, I'm not convinced though.

His response? That's an interesting theory. It would be difficult to test for especially in this country, but that's no reason not to try treatments and see if they are helpful. He adjusted his medication recommendations immediately based on this suggestion. He's researching an elimination diet to diagnose my food sensitivities.

I casually mentioned MCAS, something routinely dismissed by doctors with female patients, and he instantly took the possibility seriously.

That's it. I've reached peak male privilege. There is nothing else that could happen that could be more insane than that.

I literally keep having to hold myself back from apologizing or hedging or trying to frame my theories as someone else's idea lest I be dismissed as a hypochondriac. I told the doctor I'd like to make a big list of every health issue I have, diagnosed and undiagnosed, every theory I've been given or come up with myself, and every medication I've tried and my reactions to it - something I've never done because I knew for a fact no doctor would take me seriously if they saw such a list all at once. He said it was a good idea and could be very helpful.

Female-presenting people are of course not going to be surprised by any of this, but in my experience, male-presenting people often are. When you've never had a doctor scoff at you, laugh at you, literally say "I won't consider that possibility until you've been cleared by a psychologist" for the most mundane of health problems, it might be hard to imagine just how demoralizing it is. How scary it becomes going to the doctor. How you can internalize the idea that you're just imagining things, making a big deal out of nothing.

Now that I'm visibly a man, all of my doctors are suddenly very concerned about the fact that I've been simply living like this for nearly four decades with no help. And I know how many women will have to go their whole lives never getting that help simply because of sexism in the medical field.

If you know a doctor, show them this story. Even if they are female. Even if they consider themselves leftists and feminists and allies. Ask them to really, truly, deep down, consider whether they really treat their male and female patients the same. Suggest that the next time they hear a valid complaint from a male patient, imagine they were a woman and consider whether you'd take it seriously. The next time they hear a frivolous-sounding complaint from a female patient, imagine they were a man and consider whether it would sound more credible.

It's hard to unlearn these biases. But it simply has to be done. I've lived both sides of this issue. And every doctor insists they treat their male and female patients the same. But some of the doctors astonished that I didn't get better care in the past are the same doctors who dismissed me before.

I'm glad I'm getting the care I need, even if it is several decades late. And I'm angry that it took so long. And I'm furious that most female-presenting people will never have this chance.

[chrliekclly]

How did you get your job on sunny? I really wanna go into the entertainment industry.

iv told th story b4 but i got onto th show bcuz i just happened to b n th right place @ th right time

was working on smthn completely different nd drunk on th camera truck during one of our wrap days me, the DIT, nd the loader wer talking abt fave tv shows nd when i said tht always sunny was mine th loaders just like "oh lol funny im the 1st AC on that. i can get u some days if u want" ???

so i...did some days...then i did a season...and now im core crew i guess

[cal-is-a-cryptid]

Something that makes me happy #4:

I’m alive at the same time as Hayao Miyazaki.

[bittsandpieces]

you good?

idk how you could've possibly known but I'm actually wicked upset rn about like five different things (none of which I can do anything about)

[goldkirk]

question: have any of you personally seen a dietician (not looking for experiences with nutritionists, only dieticians), and did you find it helpful or useful, and if you did see a dietician and you ALSO have seen a GI doctor, how did the experience compare for you in terms of helpfulness + how much you felt listened to and helped?

[mxwhore]

mutuals we are struggling

[bambiraptorx]

Your body horror baby story gives me such mixed feelings because on one hand it’s so wholesome in how much Donnie is so dedicated to his little monster baby and loves them so much. Then on the other hand half the family doesn’t like Bea which I understand is a trauma response but that’s Donnie’s baby that’s so heartbreaking. Beas name for Raph being “Scared” and Mikey being “Angry” absolutely shattered me. Honestly does Donnie have any resentment towards how his family views his kid. Like I hope they’re in therapy working on that trauma because Bea is a literal baby and doesn’t deserve that suspension on her. Hell, most of her horror creature behaviors could just as easily come from Donnie.

I also want to be very clear I don’t want to come off as angry at you or hating on your story. It’s genuinely incredible and the fact I’m so emotionally invested is a testament to how well written it is. I just adore Bea and would fight god for her

Honestly yeah, it's a very complicated family dynamic. None of the family members that are uncomfortable around her want to hurt or get rid of her (partly because they know Donnie and Draxum have had mechanisms in place since the beginning to deal with a situation where that might be necessary) but that doesn't exactly go a long way in creating positive interactions.

It's also hard because, especially when she's younger, Beatrice doesn't quite understand that they don't like her. They can understand that Mikey is angry and Raph is scared, but they don't really get what's causing that. It's similar with Casey Jr being scary, because while he's not really allowed to spend much time around her, he's the one constantly looking for signs that Bea is going to reveal what he thinks of as her true Krang nature. He's the one expecting them to become a threat, and Beatrice can pick up on that.

Donnie... understands why his family sees Beatrice the way they do. He does have some trouble remembering what actually happened during the invasion, but he knows enough to be aware of just how bad it was. He knows that Raph is scared of Beatrice because of his latent fears of being used by the Krang again. He knows that Mikey uses his anger as a defense against the self blame he holds for letting Donnie go into the Technodrome in the first place. And he gets it. That doesn't stop him from wishing it was different. It doesn't stop arguments from cropping up here and there about how Beatrice gets treated.

The family does start working on therapy eventually, but it's kind of piecemeal, not everyone at once. Leo's actually the first to start, and him openly admitting he has a therapist is sort of the push his family needs to look into it themselves. It certainly doesn't fix everything, but it helps them to process stuff a bit more.

I'm glad you like this au so much! It's been super fun sharing it!

[kg-clark-inthedark]

Trying to finish writing my week 4 dhkinktober smutfic while everything is on fire at work and I’m hopelessly anxious and depressed is… challenging lmao

[tears-that-heal]

Dear Lord Help Me! 🦷🍭😖

Well….I got to finally see a dentist for the first time in almost 2 yrs. Many of you probably know what’s coming next. Yes, my teeth need some serious TLC.

What’s most frustrating is that I wish I could’ve prevented this from happening, but in the same time, since I moved to another state, finding the appropriate insurance has been a major challenge. Along with finances and etc. *sigh* Anyways, progress has been made and now I can receive decent dental help. Now for the real health report, I need to have 3 procedures to remove 2 wisdom teeth, repair broken filling and a possible root canal. 😫 Along with taking prescribed antibiotics for my gum infection, too.

Yes, my teeth are a mess! 😭

Since seeing the dentist, I’ve been staying in bed for the most part. The meds are really helping with the pain, but I’ve been also having to manage my stress and anxiety too. *sigh* Been fighting against a lot of past reacquiring insecurities like “feeling like a burden” to my family. Feeling somewhat helpless to my situation. Feeling like a baby that I can’t just push through the pain. 🥺 I can easily be too hard on myself, but I also know the great value of caring for myself; physically and mentally.

It’s more than okay to make the time to rest. It’s actually a very good lifestyle practice. Our bodies aren’t made to function 24/7, then more highly possible malfunctions will occur. I’ll, of course, make it top priority to make routine dentist visits after all this is set and done. I refuse to go through something like this with my teeth again…..but I have to get through it first. The Lord is still with me as He always is. I just need to once again trust in Him through this trial. ❤️

(images & gifs from pinterest)

[health-insurance-struggles]

Your claim got denied. Now what?

Don’t panic.

Most of the time, you can get your claim adjusted to approve.

First and foremost, find out why it was denied. Did your provider send in a duplicate? Was it an exclusion on your policy? If you know why it happened, you can figure out how to fix it (or at least make sure it doesn’t happen again).

Below are a few common reasons a claim is denied:

It’s an exclusion, aka not covered on your insurance policy. You can try to fight it by asking your doctor to send an appeal to show that the service was medically necessary, or even if your insurance company will make an exception. Either way, don’t depend on either of these things working on the back end. If you're not sure it's covered, ask BEFORE you do it.

It’s a duplicate. Your provider sent in two copies of the same claim. Your insurance isn’t going to pay it twice, so they denied the second one. No big deal; you can ignore it.

There wasn’t a prior authorization. Insurance companies usually want to make sure that whatever service you’re having is actually necessary. If your provider doesn’t get the procedure authorized before hand, your insurance company will probably deny it. This isn’t the end of the world! Most companies allow the doctor to get a retro authorization by reviewing the medical records from your procedure.

If it’s not any of these or you don’t see a reason the claim was denied, call your insurance. Don’t submit an online question because the answers that come from those almost always suck. Call and speak to a human person and ask them to look into it further. Find out what you can do or what your insurance’s policy on denials is.

Once you know what the denial is for (and if you can do something about it), your next step is almost always calling your provider. Most of the time, they’re aware of the denial before you and are already behind the scenes to get it resolved. They don’t usually need your help, but ask if you can help somehow.

And now...wait. The worst part. If there’s an appeal being filed, your insurance company has to process it. If there’s a medical records review, it has to be completed before they’ll adjust a claim.

Four times out of five, they’ll pay your claim if the provider appeals.

Finally, sometimes, it’s a mistake! Sometimes, your claim should’ve been paid and a human somewhere along the line messed up. That’s okay! Ask the claim to be reviewed. Follow-up a week later, and a week after that. It can take time, yes, but it’s better to push for a couple of weeks than to pay hundreds of dollars you shouldn’t have.

[satanicspinosaurus]

Massage has a lot of medical benefits and absolutely should be covered as part of care. One specific benefit is going in after beating your head against the wall for the last 24 hours trying to get your shoulder to stop forming a c-curve and the provider being flummoxed as well. Hits differently when a professional is like, "Why is this so tight????"

[sagabrielle]

"tortured poets" RIGHT. world-renowed struggling artist, taylor swift.

[druggeddraccus]

you know what’s actually ridiculous

i cannot put my parents on my health insurance as dependents—it’s not necessary now—they have their own because they are able to work but 20-30yrs from now? they kept me on their health insurance until i was 25. why can’t i do the same for them?

and why would it be insanely difficult to find the loop holes to be able to do this for them? it’s all just really frustrating. it’s depressing for me to research this further so what i do know about this is very limited right now. and i don’t wish to debate/discuss anything just here to rant.

[umilily]

nothing worse than having real person appointments when you don't feel like a real person

[audiovisualrecall]

Last night my mom was like okay tomorrow let's spend the day looking into the state health insurance stuff together and I was like okay great! I'll enroll in the work one and we will see if the state options are any good. I Can dream about doing The Artist Thing and not just continue to try to do the Normal (aka Neurotypical) Thing of a normal Job when my brain isn't good at that and it leads to embarrassing meltdowns and lots of stress for me.

And today.... she apparently asked dad to start working on it with me but I didn't come down for breakfast till 11 at which pt he started working on the easel he's actually decided to Make me for my birthday gift (crazy man! Looks at the ones in stores and looks at plans and decides he can do better and just goes and starts!), and he didn't mention anything to me before that, and she was at services this morning and then got some groceries and got home at like almost 1, had a snack? Lunch? And was like I'm gonna just sit down for a bit and then we can do that, but I started reading and just realized it's almost 2 so went to talk to her and she's napping. So. Idefk. I'm disappointed.